Griffith Health Institute, CONROD Griffith, Griffith University, Queensland.
Health Promot J Austr. 2011 Apr;22(1):27-32. doi: 10.1071/he11027.
This study investigated the application of an educational health promotion program, the Stanford Chronic Disease Self-Management Program (CDSM), within three Queensland Aboriginal (Murri) communities (rural, regional and urban).
A participant-observation approach was used and qualitative data was collected through interviews and focus groups. A total of 39 people participated, al of whom had been exposed to the program in different ways (i.e. leaders, health professionals, Elders who sponsored the program) during its recent deployment in their communities.
Across all three regions, Aboriginal engagement in the program was found to be influenced by core factors that are well known and reflect our general understanding about Aboriginal history (e.g. the impact of negative medica interactions, the lack of cultural competence, the use of culturally insensitive methods of service delivery, the collectivity of Murri life and the holistic concept of health). However, a more important finding was that irrespective of these broad factors, the acceptability of the program in each community depended on the extent to which it had embraced and espoused several localised processes. The impact and nature of these processes differed across each region.
Four local processes reflected the unique characteristics and profile of each community.They included the need to be responsive to local systems and structures, to incorporate local cultural traditions and knowledge bases, to use locally accepted forms of cultural communication, and to facilitate oca community participation and leadership in the program. Importantly, these factors determined the experience of the program within each community, ultimately influencing its acceptability, effectiveness and sustainability.
本研究调查了斯坦福慢性病自我管理计划（CDSM）这一教育健康促进项目在昆士兰三个原住民（毛利人）社区（农村、地区和城市）中的应用。
采用参与者观察法，通过访谈和焦点小组收集定性数据。共有 39 人参与，他们都以不同的方式（即领导、卫生专业人员、赞助该计划的长者）在该计划最近在他们的社区部署期间接触过该计划。
在所有三个地区，原住民参与该计划的程度受到核心因素的影响，这些因素是众所周知的，反映了我们对原住民历史的普遍理解（例如，负面医疗互动的影响、缺乏文化能力、使用不敏感文化的服务提供方法、毛利人生活的集体性和健康的整体概念）。然而，一个更重要的发现是，无论这些广泛因素如何，该计划在每个社区的可接受性取决于它在多大程度上接受和拥护几个本地化的过程。这些过程在每个地区的影响和性质都不同。
四个本地化的过程反映了每个社区的独特特征和特点。它们包括需要对当地系统和结构做出反应、融入当地的文化传统和知识库、使用当地可接受的文化沟通形式，以及促进当地社区参与和领导该计划。重要的是，这些因素决定了该计划在每个社区的体验，最终影响其可接受性、有效性和可持续性。
